Influence of Femoral Implant Alignment in Uncemented Total Hip Replacement Arthroplasty: Varus Insertion and Stress Shielding

Kawaji, Hidemi; Uematsu, Taro; Oba, Ryosuke; Hoshikawa, Naoya; Watanabe, Hiroshi; Takai, Shinro

doi:10.1272/jnms.83.223

Cited by 7 publications

(6 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The SS of the proximal femur has been deemed to be inversely proportional to the diameter of the proximal femoral stem, and the occurrence of SS is universally recognized in UTR, although the long-term clinical importance of SS in UTR is unclear [ 30 , 31 ]. The stiffness of press-fit prostheses with large diameters produces more SS and aggravates the resorption of the proximal femur around the prosthesis [ 30 ]. Hence, the high incidence of prosthesis revision that has been described in UTR is not unexpected and tends to be associated with differences in prosthesis materials [ 30 , 32 – 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…The stiffness of press-fit prostheses with large diameters produces more SS and aggravates the resorption of the proximal femur around the prosthesis [ 30 ]. Hence, the high incidence of prosthesis revision that has been described in UTR is not unexpected and tends to be associated with differences in prosthesis materials [ 30 , 32 – 34 ]. Studies such as these have resulted in controversy as to whether SS is merely a sign of bone resorption in this setting [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

et al. 2020

View full text Add to dashboard Cite

Background Cemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population. Methods Using our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007–2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications. Results The mean follow-up time was 62.5 months (range, 50.1–76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4–8.2] for CTR vs 16.9% [95% CI, 14.7–17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3–10.7] for CTR vs 19.9% [95% CI, 18.2–20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4–6.7] for CTR vs 13.2% [95% CI, 12.1–13.8] for UTR, p = 0.026, respectively). Conclusion CTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Over time, this cantilever phenomenon can also point load the lateral cortex at the tip of the stem, causing decreased micromotion and increased lateral cortical hypertrophy because of an altered stress-strain relationship, which can be a cause of thigh pain [19]. The abnormal loading can also lead to proximal stress shielding [7].…”

Section: Discussionmentioning

confidence: 99%

“…However, there exist no long-term, adequately powered studies assessing the varus position of cementless components [4][5][6]. It has been noted that varus-positioned cementless stems have a higher rate of stress shielding of the proximal femur, which could lead to long-term complications [7].…”

Section: Introductionmentioning

confidence: 99%

Morphology of the Greater Trochanter: An Assessment of Anatomic Variation and Canal Overhang

et al. 2020

View full text Add to dashboard Cite

Background: Varus malposition is a risk of early failure in total hip arthroplasty. The degree to which the tip of the greater trochanter (GT) overhangs the canal can increase this risk. Although we know proximal femoral anatomy is variable, no study has addressed variations in medial overhang of the GT on plain radiographs. Methods: All low anteroposterior pelvis radiographs more than 1 year were reviewed 3 times by 2 orthopaedic surgeons and one radiologist. The canal width (CW) was measured 10 cm below the lesser trochanter. Canal overhang (CO) was defined by the distance between the lateral medullary canal and a parallel line beginning at the most medial aspect of the GT. The overhang index (OI) is defined as the percentage of the canal overhung by the GT. Results: The mean CW was 13.5 mm, mean CO 16.4 mm, and mean OI 1.22. Hips were then classified as the following: (A) OI < 0.5 (n ¼ 8), (B) OI 0.5-1.0 (n ¼ 78), (C) OI 1.0-1.5 (n ¼ 191), and (D) OI > 1.5 (n ¼ 68). Intraobserver reliability was excellent for all measures: 0.89 (confidence interval: 0.87-0.91) for CW, 0.96 (0.95-0.97) for CO, and 0.97 (0.97-0.98) for OI. Interobserver reliability was good for CW 0.75 (0.70-0.79) and excellent for CO 0.90 (0.88-0.92) and OI 0.95 (0.94-0.96). Conclusions: Variations in the morphology of the proximal femur can predispose to varus component malposition. The degree to which the GT overhangs the canal can be quantified and classified based on plain films. This can aid in preoperative planning and help guide intraoperative proximal femoral preparation.

show abstract

“…Cementless THA has been widely accepted to obtain the biological bone fixation of the implant, but proximal bone resorption around the stem occurs frequently with this procedure [ 2 , 3 ]. The implantation of femoral component may lead to osteopenia of the proximal femur due to stress shielding [ 4 , 5 ]. Periprosthetic bone loss after THA is associated with reduced bone mineral density (BMD) which increases the risk of migration, implant loosening, and periprosthetic fractures [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up

Yang¹

2018

J Orthop Surg Res

View full text Add to dashboard Cite

BackgroundRecently risedronate is suggested to be effective for the prevention and treatment of for osteoporosis in total hip arthroplasty. This meta-analysis aimes to evaluate the efficacy of risedronate in reducing femoral periprosthetic bone mineral density loss in patients undergoing primary total hip arthroplasty.MethodsA systematic search was performed in Medline (1966-31 October 2017), PubMed (1966-31 October 2017), Embase (1980-31 October 2017), ScienceDirect (1985-31 October 2017) and the Cochrane Library. Only randomized controlled trial (RCT) were included. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed using Stata 11.0 software. The outcome measures included periprosthetic bone mineral density, length of stay and adverse effects.ResultsFour RCTs including 198 patients met the inclusion criteria. The present meta-analysis showed that there were significant differences between treatment groups in terms of periprosthetic bone mineral density in Gruen zones 1 (standard mean difference (SMD) = 0.758, 95% CI 0.469 to 1.047, P = 0.000), 2 (SMD = 0.814, 95% CI 0.523 to 1.106, P = 0.000), 3 (SMD = 0.340, 95% CI 0.059 to 0.622, P = 0.018), 6 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000), and 7 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000).ConclusionOral risedronate could significantly reduce periprosthetic bone resorption around an uncemented femoral stem (Gruen zones 1, 2, 3, 6, and 7) up to 6 months after THA. In addition, no severe adverse events were identified. Future trials of risedronate treatment after THA should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.

show abstract

Influence of Femoral Implant Alignment in Uncemented Total Hip Replacement Arthroplasty: Varus Insertion and Stress Shielding

Cited by 7 publications

References 10 publications

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

Morphology of the Greater Trochanter: An Assessment of Anatomic Variation and Canal Overhang

The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up

Contact Info

Product

Resources

About